MEDICARE: CHARLESTON PATHOLOGY ASSOCIATES PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CH9446	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720087596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLESTON PATHOLOGY ASSOCIATES PLLC

Provider Business Mailing Address
First Line	:	PO BOX 611
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25322-0611
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 LAIDLEY ST
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25301-1614
Country	:	US
Telephone Number	:	304-347-6694
Fax Number	:

Authorized Official
Title or Position	:	MD MEMBER
Name	:	DR. MICHAEL W SOBIESKI
Credential	:	MD
Telephone Number	:	304-347-6694

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	08/10/2007

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